Cutaneous melanoma is a malignant neoplasm with local and distant metastatic potential. When feasible, surgery is the first line of treatment in locoregionally advanced disease. Topical and intralesional treatments can be an alternative second-line treatment. The aim of this article was to perform a narrative review of the most widely used topical and intralesional treatments for locoregionally advanced melanoma. Diphenciprone, imiquimod and 5-florouracil were included as topical treatments and bacillus Calmette-Guerin, interleukin 2, rose bengal, talimogene laherparepvec and electrochemotherapy were included as intralesional treatments. Brief comments on other alternatives in development such as interferon-alpha, interleukin-12, ipilimumab and intralesional daromun are presented. Topical treatments generally have higher response rates in epidermal metastases than in deeper metastases. In addition, the larger the lesions, the worse they tend to respond to local treatments. Some reports show that combining certain systemic treatments and topical or intralesional therapies can improve response rates. It has also been described in a few papers that non-injected lesions may respond after the application of a local therapy in distant skin-metastases. Many of these intralesional treatments are being combined in different investigations with systemic immunotherapies, with the aim of obtaining synergic responses in those patients with refractory disease.
皮肤黑色素瘤是一种具有局部和远处转移潜能的恶性肿瘤。对于局部晚期病变，手术在可行时是首选治疗方案。局部病灶内治疗可作为替代性二线治疗选择。本文旨在对局部晚期黑色素瘤最常用的局部及病灶内治疗方案进行叙述性综述。局部治疗包括二苯基环丙烯酮、咪喹莫特和5-氟尿嘧啶；病灶内治疗涵盖卡介苗、白细胞介素2、孟加拉玫瑰红、他利莫根拉赫帕雷维和电化学疗法。文中还简要评述了处于研发阶段的其他替代方案，如干扰素-α、白细胞介素-12、伊匹单抗以及病灶内注射达罗蒙。局部治疗对表皮转移灶的应答率通常高于深层转移灶。此外，病灶体积越大，对局部治疗的反应往往越差。部分研究表明，特定全身治疗与局部或病灶内治疗联用可提高应答率。另有少数文献报道，在远处皮肤转移灶实施局部治疗后，未经注射的病灶也可能产生应答。目前多项研究正在探索将多种病灶内治疗与全身免疫疗法联合应用，以期在难治性患者中实现协同治疗效果。
Topical and Intralesional Treatments for Skin Metastases and Locoregionally Advanced Melanoma
肿瘤(癌症)患者之家